Radiotherapy

When you’re diagnosed with a brain tumour, radiotherapy is one

type of treatment you may have.

Radiotherapy, or radiation treatment, uses controlled doses of

invisible, high energy beams of charged particles.

These are targeted at the tumour to destroy the tumour cells, while

causing as little damage as possible to surrounding healthy cells.

Radiotherapy may be used where surgery isn’t possible, or after

surgery to kill any remaining cells. It can also be used to prevent a

tumour from returning or slow down the growth of the tumour.

In this fact sheet:

What happens if I’m given radiotherapy?

What are the side-effects of radiotherapy?

Answers to other questions you may have about radiotherapy to

the brain

Please see other fact sheets for information about specialist types of

radiotherapy - Proton Beam Therapy (PBT) and Stereotactic Radiotherapy

(SRT).

This fact sheet is relevant to brain tumours in adults - for fact sheets and other resources

for children, please see www.thebraintumourcharity.org

What happens if I’m given radiotherapy?

Before you’re given radiotherapy treatment, a lot of planning and preparation

is needed. This is to make sure the treatment is as effective as possible whilst

minimising the side-effects.

Before radiotherapy treatment

Planning

Your radiotherapy treatment is very carefully planned by a team of medical

specialists to make sure it reaches and destroys as many tumour cells as

possible, while avoiding as much healthy tissue

as possible.

The team will consist of specialists, always including a clinical oncologist

(specialising in radiotherapy), a radiographer (trained in using x-ray

equipment) and a medical physicist (who you would not usually meet, but

who specialises in radiation).

First, you’ll have a radiotherapy planning scan. This is usually a CT

(Computerised Tomography) scan, but sometimes is an MRI (Magnetic

Resonance Imaging) scan .

For more information, see the Scans for adults with brain tumours webpage

and fact sheet.

The scan creates a 3D image of your tumour, showing its shape and location

within the brain. Together, the image and measurements from the scan help

your medical team make precise plans about where to target the

radiotherapy.

Sometimes an additional imaging machine, called a simulator, is used either

to plan simple brain treatments or to check the complex treatment planned

from the CT scan.

All efforts will be made to avoid more critical areas of the brain. These areas

include the brain stem (responsible for functions such as breathing and heart

rate); the optic nerve (which helps you see); and the cochlear in the ear (to

reduce long-term hearing loss).

Sometimes it’s impossible to avoid more critical areas of the brain

without compromising treatment.

So depending on your tumour and its location, you may need to be

given radiotherapy which includes one or more of these areas.

As well as helping to plan the area to be targeted, the scan also helps the

medical physicist plan the doses of radiation and how the treatment should be

‘staged’.

This means how many sessions of radiotherapy will be needed and how

much radiation needs to be given at each treatment session. This is important

as it gives the normal cells time to recover before the next dose of radiation.

Treatment mask

It’s important to lie very still during treatment, so that the radiotherapy is

directed at the right part of the brain.

To help you stay still, you’ll have a treatment mask designed and made

especially for you to wear each time you have treatment.

It’s made specifically to fit your head and fixes to the treatment couch to hold

your head in the same position and place each time you have radiotherapy.

How the mask is made:

Your mask may either be made in the ‘mould room’ or the room where

you have your planning CT scan at the hospital.

It will take about 30 minutes to make the mask, though you should allow

more time for the whole process.

Different hospitals use different materials to create the mask.

This may mean having a Plaster of Paris impression taken of your face

to make a Perspex mask.

More commonly, centres use a thermoplastic material to make the

mask. This is a plastic that goes soft and mouldable in warm water.

The thermoplastic mesh is warmed in water to make it soft.

The mesh is then smoothed onto your face, so that the final mask

is an exact replica of the size and shape of your head.

It will feel warm as it sets and has sometimes been described as a bit

like having a warm flannel pressed onto your face.

Gaps will be made for your eyes, nose and mouth, so you’re always

able to breathe easily.

The mask only needs to be worn during the planning and when you

have radiotherapy. You don’t need to wear it at other times.

To see a video of how a radiotherapy mask is made, see the Cancer

Research UK video: bit.ly/radiotherapy-mask

Once the mask is made:

Your radiographer (a specialist in giving radiotherapy) will make ink

marks on the mask. These are used to help position you more easily

each time you have radiotherapy treatment and will make the process

smoother.

If you’re having craniospinal (whole brain and spine) radiotherapy, you

may also have some very small markings put on your skin to line up the

rest of your body.

During radiotherapy treatment

Your treatment is planned to suit your individual needs, so may be very

different to the treatment of other people you may meet.

During treatment:

You’ll lie on the radiotherapy bed with the radiotherapy machine above

you.

Medical staff will take some time positioning you to make sure the

radiotherapy goes to the correct place.

During the positioning, the radiographer will place your mask over your

head and attach it to the table to prevent you from moving. This will

stay on for the duration of the individual treatment, which is called a

fraction.

Before the radiotherapy machine is switched on, the medical staff will

leave the room.

This is to prevent giving any radiation to people who don’t need it.

The medical staff will be nearby though and easily able to hear, see and

speak to you. You’ll also be able to hear and speak to them.

There are a number of different types of radiotherapy machine. Some

may move around you during treatment, while others look more like a

CT scanner. (See the Scans for adults fact sheet.)

Hospitals will often allow you to take a CD along, so you can listen to

your music while you’re having radiotherapy.

Once the treatment is finished, the medical staff will come back into the

room. They’ll detach the mask from the radiotherapy table and remove

it, so you can sit up and get off the table.

The medical staff will keep your mask until the next treatment session.

How long will treatment take?

Treatment times will vary, depending on your individual treatment plan.

Each session of radiotherapy (fraction) generally lasts only a few minutes,

though it can be as short as a few seconds.

Your appointment as a whole will take considerably longer, due to the

medical staff spending time positioning you to make sure you’re in the right

place.

If you’re having radiotherapy to the brain and spine (known as craniospinal

radiotherapy), it can take a bit longer.

An example of a typical radiotherapy plan is treatment once a day, Monday to

Friday, with a break at the weekends.

The period of time over which your radiotherapy is spread will also depend on

your treatment plan, but it’s common for it to last for around 4 to 6 weeks.

Simple treatments are usually much shorter - a few days to 2 weeks.

Before the treatment begins, your medical team will be able to tell you how

many sessions you’ll need, how often and over what period. They’ll also be

able to give you a guideline for how long each visit to the hospital should

take.

After radiotherapy treatment

Generally radiotherapy is given as an outpatient, so you’ll be able to go home

after each session. Occasionally, if you feel unwell, you may have to stay in

hospital overnight. If you’re in hospital having another treatment, such as

chemotherapy, you can go back to your ward.

Once the whole course of treatment is complete, you can take your treatment

mask home, if you want to.

Some people use them to hang their earrings, headphones or hats on. They

can help friends and family understand the treatment you’ve gone through.

Following treatment, you’ll have regular check-up appointments to monitor the

effects of the radiotherapy on your tumour and any

side-effects you may get.

You’re likely to experience some side-effects. Some of these will be

temporary and gradually clear once the treatment has finished. Others may

be long-term.

What are the typical immediate side-effects

of radiotherapy?

Radiotherapy works because it does the greatest damage to rapidly dividing

cells, such as tumour cells. However, it can also affect any normal cells within

the treatment area, particularly those which also divide rapidly.

Rapidly dividing cells include skin cells, cells lining the mouth and the

digestive tract, plus blood cells in the bone marrow. These areas, therefore,

tend to have the most common side-effects.

You may find it helpful to ask your doctor about the side-effects you might

experience.

Generally, the more immediate side-effects will gradually disappear within

around 6-12 weeks after treatment finishes.

Common side-effects of radiotherapy include:

Tiredness

You’re very likely to feel tired during your treatment and, as the weeks of

radiotherapy go on, this tiredness could increase.

This may be because your body is using its resources to repair any damage

to healthy cells caused by the radiotherapy, or because of all the journeys to

and from the hospital.

Unfortunately, the feeling of tiredness doesn’t go away immediately once the

treatment stops and could continue for a number of weeks.

Let yourself rest or nap when you need to and don’t feel you must fight the

tiredness. Try to plan rest breaks into your days even if you’re not feeling

tired.

Health teams now encourage all patients to do at least 30 minutes gentle

exercise every day to minimise radiotherapy-induced fatigue. This could be a

gentle walk.

For more information, including practical tips on coping with fatigue, see the

Fatigue webpage and fact sheet.

Hair loss

Unfortunately, you will lose some hair during radiotherapy, and this can be

quite distressing for you.

Generally, your hair will only be lost from the places where the radiotherapy

beam enters and leaves your head. If, however, you have whole brain

radiotherapy, you’re likely to lose hair from your whole head. You can talk to

your radiographer about where you’re most likely to lose hair.

Knowing that there’ll be some hair loss means that you can plan ahead.

Take a picture of how you usually wear your hair, so that a hairdresser can

shape a wig. You could also keep a lock of your hair to match the colour and

texture.

Some people have found gradually cutting their hair shorter, or even shaving

it all off, before the start of treatment can help it feel less of a shock.

Hair loss usually starts around 3 weeks after treatment starts. Most hair loss

is temporary, and will begin to grow again 2-3 months after finishing

treatment.

Re-growth is often not as thick as it was before, and your hair may not be the

same colour or texture. For example, it may be curly, when it was straight

before. For some people, hair loss can be permanent.

There are many styles of wig that you can choose from, including synthetic

(monofibre) and human hair wigs. And also lots of places that sell hats,

bandanas or wigs and hairpieces as practical suggestions for coping with hair

loss.

See the Resources section later in this fact sheet for details.

Skin sensitivity

During or a few weeks after radiotherapy, some people develop changes to

their skin in the area being treated, i.e. on your scalp.

These can be like sunburn (red, blotchy and itching) in people with pale skin,

and darkening of the skin in those who have darker skin.

As your skin will be more sensitive after radiotherapy, you should take care to

protect it from strong winds and the sun. Always wear suntan lotion and a

sunhat with neck protection when you’re outside.

Usually, the sensitivity will fade in the month or so after treatment, but you

should keep using high factor sunscreen long-term on the areas of the skin

that have had radiotherapy.

This is because radiotherapy can permanently destroy the pigment-producing

cells in your skin. These cells enable you to tan and protect you from sunlight

damage and developing skin cancer.

Your health team will be able to give you further guidance if

you develop skin sensitivity.

Feeling sick (nauseous)

If you have radiotherapy to the lower part of your brain, you may feel sick or

actually be sick following treatment.

This can start from around an hour after treatment and last some weeks. Your

doctor can give you anti-sickness tablets to manage this.

Reduced appetite

Feeling sick and tired can make some people temporarily lose their appetite

during radiotherapy. This can lead to weight loss.

You may find it easier to eat several smaller snacks throughout the day,

rather than three ‘regular’ meals. Or ask your health team if they can refer

you to a dietitian.

For more information, see the Diet webpage and fact sheet.

Myelosuppression

(slowing of the production of blood cells by the bone marrow)

Radiotherapy can temporarily slow the production of blood cells by the bone

marrow.

Low blood cell counts are usually not severe enough to cause major

problems. When there is a break from treatment for a few days, blood cell

counts usually recover.

However, the low levels can sometimes lead to anaemia, increased risk of

infection and/or bleeding, such as bruising or nosebleeds.

If you’ve had radiotherapy to the brain and spine, or if you’re also having

chemotherapy, you’re more at risk of these effects.

Worsening of symptoms

Radiotherapy to the brain can cause swelling in the treatment area. This

swelling increases the pressure in the head, so can sometimes make

symptoms worse before they get better.

Your doctor might give you steroids to try to prevent this. Your symptoms

usually get better in time.

See the Steroids for adults with brain tumours webpage and fact sheet for

more information.

Your health team will discuss possible side-effects with you before you have

treatment. Feel free to ask them any questions at any time if you have

concerns.

Will there be any long-term side-effects

of radiotherapy?

Once the whole course of treatment is complete, you’ll have regular check-up

appointments to monitor the effects of your radiotherapy treatment. Generally,

side-effects, apart from hair loss, will gradually disappear within around 6-12

weeks.

It’s important to know that radiotherapy is given in a way designed to

limit the chance of permanent side-effects as much as possible.

Very few people develop long-term difficulties.

Occasionally, some side-effects can be longer-term or develop later in life.

Your health team will talk through any side-effects with you before any

treatment is given.

Long-term effects of radiotherapy could include impacts on:

Cognitive skills

Cognitive skills include thinking, memory, learning, concentration, decision-

making and planning. They also include processing skills, such as

recognising and making sense of information from your senses, particularly

sight and hearing.

If a large part or the whole of your brain is treated, there is a long-term risk of

cognitive impairment.

For further information, see the Cognition and brain tumours webpage and

fact sheet.

Vision

If the radiotherapy is delivered near to your eyes, there’s a chance of

developing a cataract in the lens of the eye several months or even years

later. Cataracts can make your vision cloudy, blurred or dim. However, they

can usually be easily treated with a simple, small operation.

Hormonal effects

Radiotherapy treatment that includes the pituitary gland at the base of the

brain can affect the production of the various hormones that the pituitary

controls.

This can cause a variety of symptoms related to functions such as body

temperature, growth, salt and water balance, sleep, weight

and appetite.

As part of your follow-up after radiotherapy, you may have blood tests to

check your hormone levels, but if you notice any new symptoms, you should

discuss them with your doctor.

Second tumour

Radiotherapy can cause changes that, over a long period, can lead to a

second tumour developing.

However, the benefits of having radiotherapy far outweigh the risks, and only

a small number of people will develop a second cancer because of the

treatment they’ve had.

Long-term side-effects can take months and sometimes years to

develop.

Other frequently asked questions

Will the treatment be painful?

No, you can’t see or feel the radiotherapy beams and you won’t feel any heat

from it either.

You’ll hear the machine though, which can be quite noisy.

The Brain Tumour Charity animation about radiotherapy for children includes

a sample of the noise. thebraintumourcharity.org/jake

Will I be radioactive after my treatment?

No. The radiation comes from the machine and does not stay inside your

body. You don’t need to take special precautions when you leave the

hospital. It’s safe to be around others, including children.

Will I need to give up work?

It’s likely that you’ll need to take some time off work during treatment and for

at least a little while afterwards.

Precisely when you go back to work must be your decision. It’s important that

you don’t feel pressurised to go back too soon and that you do what feels

right for you.

Some people find it helpful to return to work as soon as possible, as it gives

them something else to focus on. For others, it’s months before they feel

ready.

Your health team may be able to signpost you to organisations that can help

you return to work, or contact The Brain Tumour Charity for information.

For more information, see the Employment resources webpages and

downloadable resources.

Why is the treatment given in several small doses instead of

one large dose?

The full dose of radiation you need will be carefully calculated, depending

partly on the size, type and location of the tumour.

The dosage is then divided into a number of smaller doses called fractions.

There are two main reasons for this.

The first is that the sensitivity of a cell to radiation depends on where it is in its

growth cycle.

Giving radiotherapy in several doses means that the tumour cells will receive

radiation when they’re in their most sensitive stage.

The second reason is to allow healthy cells to recover between treatments.

Cells that grow and divide quickly (tumour cells) are much more sensitive to

radiation than non-dividing, resting (normal) cells. Having a gap between

doses gives the normal cells time to recover while still causing damage to the

tumour cells.

Resources

Wigs and other headwear

There are many different styles of wig to choose from, including synthetic

(monofibre) and human hair wigs. You can also buy headscarves and other

headwear.

You can get free synthetic wigs on the NHS if:

you live in Scotland, Wales or Northern Ireland

(via free prescriptions)

you live in England and:

you're under 16, or under 19 and in full-time education

you're a hospital inpatient

your weekly income is low

you apply to the NHS Low Income Scheme and receive an HC2

certificate for full help with health costs

you have a valid NHS tax exemption certificate

you're a war pensioner, the wig is for your accepted disablement and

you have a valid war pension exemption certificate.

People in England who are receiving treatment for cancer, the effects of

cancer, or the effects of current or previous cancer treatment now get free

prescriptions. This includes a prescription for a synthetic wig.

Disclaimer: The Brain Tumour Charity provides the details of other

organisations for information only. Inclusion in this fact sheet does not

constitute a recommendation or endorsement. The following list is not

exhaustive.

Other suppliers

Afrostyling

This is an online retailer selling wigs, extensions and other hairpieces.

afrostyling.com or 0161 870 2387

Annabandana

Selection of headwear that can be ordered online or by phone.

annabandana.co.uk or 01297 553747

Bohemia Fashions

Headwear for men, women and children with hair loss, including sleep caps

and padded headscarves.

bohemiaheadwear.co.uk or 01582 750083

Chemotherapy Headwear

Sells hats and headscarves for people experiencing hair loss.

chemotherapyheadwear.com or 01483 901403

Direct Wigs

Online seller of both men and women’s wigs, hair pieces and scarves.

directwigs.co.uk or 01793 632152

Hairware

Large selection of wigs, hats and other accessories. Approved by NHS for

prescription wigs.

hairware.com or 0845 713017

My New Hair

Charity that provides support and advice for medical hair loss, plus a network of salons

providing wig styling.

mynewhair.org

Little Princess Trust

Provides free real-hair wigs to young adults (male and female) up to the age

of 24, who have lost their own hair through cancer treatment.

littleprincesses.org.uk or 01432 760060

Hero by LPT

Part of the Little Princess Trust, this service was set up in response to some

boys not being comfortable receiving a wig from a charity called Little

Princess Trust. It provides free real hair wigs to boys and young men up to

the age of 24, who have lost their hair through treatment for cancer.

herobylpt.org.uk or 01432 760060

Hair4U

Offers free real hair wigs and a salon styling experience for young people

aged 13-24 (male and female) nationwide. Set up by Teenage Cancer Trust.

teenagecancertrust.org/about-us/what-we-do/hair4u

or 0207 612 0370

WigBank

A network of wig banks around the UK that offer new and donated wigs for

sale. People donate wigs they no longer need. The wigs are washed,

disinfected, conditioned and sold from £20, with £5 going to a cancer charity

of the buyers choice.

wigbank.com or 0131 336 5100

Wig-Wham

Provides a personal service for women to try on wigs in her private studio.

Can offer evening and weekend appointments.

wig-wham.co.uk or 01785 823531

The Institute of Trichologists

Gives information about hair grafts.

trichologists.org.uk or 0845 604 4657

What if I have further questions or need other support? You can contact our Information and Support Team in the following ways:

Call 0808 800 0004 (free from landlines and most mobiles including 3, O2,

EE, Virgin and Vodafone)

Email: support@thebraintumourcharity.org

Live Chat: Get in touch with us online via

thebraintumourcharity.org/live-chat

Join one or more or our closed Facebook groups: bit.ly/FBSupportGroups

Website: thebraintumourcharity.org/getsupport

Disclaimer This resource contains information and general advice. It should not be used

as a substitute for personalised advice from a qualified specialist

professional. We strive to make sure that the content is accurate and up-to-

date, but information can change over time.

Patients must seek advice from their medical teams before beginning or

refraining from taking any medication or treatment.

The Brain Tumour Charity does not accept any liability to any person arising

from the use of this resource.

About this information resource The Brain Tumour Charity is proud to have been certified as a provider of

high quality health and social care information by The Information Standard –

an NHS standard that allows the public to identify reliable and trustworthy

sources of information.

Written and edited by our Information and Support Team, the accuracy of

medical information in this resource has been verified by leading health

professionals specialising in neuro-oncology.

Our information resources have been produced with the assistance of patient

and carer representatives and up-to-date, reliable sources of evidence.

We hope that this information will complement the medical advice you have

already been given. Please do continue to talk to your medical team if you are

worried about any medical issues.

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would like more information about how we produce them, please contact us.

We welcome your comments on this information resource, so we can

improve. Please give us your feedback via our Information and Support

Team on 0808 800 0004 or support@thebraintumourcharity.org

About us The Brain Tumour Charity is at the forefront of the fight to defeat brain

tumours and is the only national charity making a difference every day to the

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Radiotherapy for adults with brain tumours

Your notes

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Version 5.0 (clear print). First produced in standard print format May 2018.

Review date, May 2021.